Rotationplasty for Severe Congenital Femoral Deficiency

Rotationplasty is a reconstructive option for severe congenital femoral deficiency (CFD). The senior author (D.P.) developed five new rotationplasty techniques for use in CFD based on the Paley classification, including the Paley–Brown (fusion femur to pelvis), Paley (fusion femur to femoral head), Paley–Winkelman (insertion tibial condyle to acetabulum), PaleySUPERhip–Van Nes (hip osteotomy with knee fusion) and PaleySling–Van Nes (hip reconstruction with knee fusion revision) rotationplasty techniques. The purpose of this study is to retrospectively evaluate the complications, radiographic outcomes and need for secondary surgery in 19 rotationplasty cases performed by the senior author (D.P.) for severe CFD from 2009 to 2019. Rotationplasty comprised only 2% of the authors treated CFD cases during this period. Average age at surgery was 8.6 years old. Average follow-up was 3.3 years. Sixteen concomitant procedures were performed including temporary arthrodesis, tibial osteotomy and SUPERhip procedure. The most common complication was wound necrosis/dehiscence, which occurred in 52% of the cases related to the circumferential incision and required a total of 31 additional debridements. Additional complications were successfully treated and included sciatic nerve palsy decompressed by abducting the femur, a tibial delayed union that underwent bone grafting, two distal femur failed epiphysiodesis treated by revision with one osteotomy and a thigh compartment syndrome requiring debridement. Indication specific rotationplasty successfully addresses the severe degree of femoral deficiency, deformity, and discrepancy in patients with CFD, despite high rates of wound complications.

Download Full-text

Preliminary Experience Using Bioactive Glass Wedges for Cotton Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418796861 ◽

2018 ◽

Vol 3 (4) ◽

pp. 247301141879686

Author(s):

Tood Borenstein ◽

Tyler Gonzalez ◽

Janet Krevolin ◽

Bryan Den Hartog ◽

David Thordarson

Keyword(s):

Bioactive Glass ◽

Case Series ◽

Clinical Results ◽

Delayed Union ◽

Complication Rates ◽

Level Of Evidence ◽

Opening Wedge ◽

Radiographic Outcomes ◽

Initial Correction

Background: Medial cuneiform dorsal opening wedge (Cotton) osteotomy is often used for treating forefoot varus in patients undergoing surgery for stage II posterior tibialis tendon dysfunction. The goal of this study was to examine the radiographic outcomes of Cotton osteotomy with bioactive glass wedge to assess for both maintenance of correction and clinical results and complications. We hypothesized that bioactive glass wedges would maintain correction of the osteotomy with low complication rates. Methods: Between December 2015 and June 2016, the charts of 17 patients (10 female and 7 male) who underwent Cotton osteotomy using bioactive glass wedges were retrospectively reviewed. Patient age averaged 56.8 years (range, 16-84). The average follow-up was 6.5 months. Radiographs were reviewed to assess for initial correction and maintenance of correction of medial column sag as well as for union. Charts were reviewed for complications. Results: The medial column sag correction averaged 15.6% on the final postoperative lateral radiograph. Meary angle averaged 19 degrees (3.14-42.8 degrees) preoperatively and 5.5 degrees (0.4-20.7 degrees) at final follow-up. All patients achieved clinical and radiographic union. One patient developed neuropathic midfoot pain and was managed with sympathetic blocks. One patient had a delayed union that healed at 6 months without surgical intervention. No patients required the use of custom orthotics or subsequent surgical procedures. Conclusion: Cotton osteotomy with bioactive glass wedges produced consistent correction of the medial column with low risk. Level of Evidence: Level IV, case series.

Download Full-text

Accuracy of Correction and Postoperative Complications Associated with a PEEK Opening Wedge High Tibial Osteotomy Implant

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00497 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0049

Author(s):

Derek Axibal ◽

Christopher Joyce ◽

Darby Houck ◽

Stephanie Logterman ◽

Rachel Frank ◽

...

Keyword(s):

Postoperative Complications ◽

High Tibial Osteotomy ◽

Senior Author ◽

Type I ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Correction Angle ◽

Medial Cortex ◽

Wedge High Tibial Osteotomy

Objectives: To evaluate the accuracy of correction angle of an all-PEEK medial opening wedge high tibial osteotomy (HTO) system, as well as determine the effect of correction angle on postoperative complications. Methods: Retrospective review was performed on patients who underwent an HTO by the senior author using an all-PEEK HTO system between 2014-2018 with a >6-month follow-up were included. Measurements were performed and classifications formulated by three senior residents and the senior author. Lateral hinge fractures (LHF) were classified according to Takeuchi classification system. Bivariate statistics were performed. Results: Thirty HTOs in 27 patients were included (50% female; age, 37.8±10.8 years). Average follow-up was 16.2±10.1 months. Average post-operative radiographic valgus correction (Δ, 5.8±2.4°) was significantly less than that of the average implant correction angle (8.1±2.3°; p<0.001), indicating an overall average under-correction of 2.3±2.1°. There were 5 failures (16.7%; defined as approximately >5° loss of planned correction) that shared a common mechanism of medial cortical failure inferior to the implant. When selecting out the construct failures, the average correction accuracy of the 25 (83.3%) non-failures (1.5±1.2°) was significantly better than the 5 (16.7%) failures (6.3±1.8°; p=0.002). Four fractures (13.3%) were identified: 3 (10%) Takeuchi type I and 1 (3.3%) type III. All type I fractures were associated with >5° planned correction loss with medial cortex buckling. Overall, 9 knees (30%) experienced minor complications: neuropathy (n=1; 3.3%), deep vein thrombosis (n=2; 6.7%), and superficial infection (n=3; 10%). Conclusion: The use of an all-PEEK medial opening wedge HTO implant is a safe and effective system, with an acceptable average under-correction of 1.5° in patients not sustaining medial cortex failure. Loss of correction was associated with medial cortex failure and Takeuchi type I LHF. This is the first description of this failure mechanism (medial cortex buckling) that is specific to this implant and technique.

Download Full-text

Fixation of posterior malleolus fractures through posterior access in the ankle

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.779 ◽

2018 ◽

Vol 12 (3) ◽

pp. 193-198

Author(s):

Vitor Yoshiura Masuda ◽

Vinicius Felipe Pereira ◽

Daniel Soares Baumfeld ◽

Caroline Marques Dos Santos Cavaleiro Cruel Neves ◽

Caio Nery ◽

...

Keyword(s):

Case Series ◽

Score Function ◽

Wound Complications ◽

Joint Degeneration ◽

Aofas Score ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Posterior Malleolus ◽

The Mean

Objective: The aim of this study is to present the preliminary results of posterior malleolus fixation in a case series by evaluating clinical and radiographic outcomes as well as possible complications related to this approach. Methods: This study involved a case series of 7 patients with posterior malleolus fractures, either isolated or associated with other tibiotarsal injuries, who were surgically treated and evaluated from January 2014 to December 2016 in one of the hospitals of our service. The patients were evaluated for consolidation, pain (Visual Analog Scale (VAS) score), function (American Foot and Ankle Society (AOFAS) score), surgical wound complications and joint degeneration in the postoperative period. Results: The mean follow-up was 66 weeks. All patients presented clinical and radiographic consolidation of the fractures by the sixth weekof the follow-up. The mean pain score according to the VAS was 1.5 and the mean AOFAS score was 92.5. At the end of follow-up, no clinical or radiographic evidence of joint degeneration was observed. Conclusion: Posterior access is a viable alternative that provides good results with few complications for the treatment of posterior malleolus fractures. Level of Evidence IV; Therapeutic Studies; Case Series.

Download Full-text

Stenting as Monotherapy for Uncoilable Intracranial Aneurysms

Operative Neurosurgery ◽

10.1227/neu.0b013e31827fcaba ◽

2012 ◽

Vol 73 (suppl_1) ◽

pp. ons80-ons85 ◽

Cited By ~ 2

Author(s):

Ketan R. Bulsara ◽

Gregory A. Kuzmik ◽

Ryan Hebert ◽

Vincent Cheung ◽

Charles C. Matouk ◽

...

Keyword(s):

Clinical Condition ◽

Intracranial Aneurysms ◽

Senior Author ◽

Radiographic Outcomes ◽

Effective Option ◽

Good Clinical Condition ◽

Aneurysm Occlusion ◽

Flow Diverters

Abstract BACKGROUND: Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that warrants further investigation. OBJECTIVE: To clarify the role of oversized self-expanding stents as monotherapy for BLAs. METHODS: Five consecutive patients were treated for BLAs with oversized self-expanding stents alone by the senior author (K.R.B.). We report on their clinical and radiographic outcomes. RESULTS: All 5 patients in our series were discharged in good clinical condition. Complete aneurysm occlusion was observed in all patients at the time of most recent radiographic follow-up. Mean follow-up time was 13.6 months (range, 1 month to 4.5 years). CONCLUSION: The use of oversized self-expanding stents to redirect flow away from aneurysms is an effective option for patients with BLAs. This approach represents an alternative to the use of flow diverters.

Download Full-text

The Retrograde Drilling for Osteochondral Talar Lesion in Children

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00305 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0030

Author(s):

So Minokawa ◽

Ichiro Yoshimura ◽

Kazuki Kanazawa ◽

Tomonobu Hagio ◽

Takuaki Yamamoto

Keyword(s):

Clinical Outcomes ◽

Nonoperative Treatment ◽

Skeletally Immature ◽

Retrograde Drilling ◽

Radiographic Outcomes ◽

Ct Findings ◽

Ankle Ligament ◽

Age At Surgery ◽

Lateral Ankle Ligament

Category: Ankle, Arthroscopy Introduction/Purpose: Osteochondral talar lesions (OCL) are infrequent in children, and little is known about the treatment and clinical outcome of these defects. Clinicians normally first attempt nonoperative treatment of these lesions, but if such treatment fails, surgical many treatments including retrograde drilling (RD), are attempted. RD is usually reserved for large OCLs with intact overlying cartilage. Good clinical outcomes have been reported in RD. However, the clinical outcomes of RD for OCL in children remains unclear. The purpose of this study was to evaluate the clinical and radiographic outcomes of RD in skeletally immature children. Methods: From January 2015 to April 2018, RD was performed on eight feet with OCL in six consecutive patients in skeletally immature children. Arthroscopic lateral ankle ligament repair was also performed in one of the eight feet, and one foot was excluded; therefore, we studied seven feet in five patients. The patients comprised three boys and two girls with a mean age at surgery of 11 (range, 9–12) years. All patients were followed for a minimum of 6 months postoperatively, the average follow-up was 19.1 (range, 8–39) months. All patients were grade 0, determined according to a modified Pritsch classification system. All patients were evaluated for Japanese Society for Surgery of the Foot (JSSF) scale and radiographic outcomes at preoperatively and postoperatively final follow up. Results: The average JSSF scale improved from 79.4 points (range, 69–90 points) to 100 points in all feet at final follow-up (p<0.01). The postoperative size of OCL using CT findings was improved than preoperative size. According to the postoperative computed tomography (CT) findings, four feet were good, three foot were fair. There were no incidences of postoperative complications. Conclusion: In our study, we suggest that RD for OCL in skeletally immature children is effective surgical treatment.

Download Full-text

Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis and Severe Hindfoot Deformity: A Systematic Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00210 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0021

Author(s):

Amanda N. Fletcher ◽

Jordan L. Liles ◽

Gregory F. Pereira ◽

John Steele ◽

Samuel B. Adams

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Weighted Average ◽

Wound Complications ◽

Bone Block ◽

Inclusion Criteria ◽

Operative Techniques ◽

Radiographic Outcomes ◽

Subtalar Arthritis

Category: Hindfoot; Trauma Introduction/Purpose: Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objectives of this study were (1) to conduct a systematic review of clinical outcomes following SDA, (2) to assess the demographics, indications, and surgical technique used, (3) to assess the clinical and radiographic outcomes of this procedure and its role in improving function, (4) to provide treatment recommendations based on the best available literature, and (5) to identify knowledge deficits that require further investigation. Methods: MEDLINE and EMBASE were queried with an end date of January 1, 2018 using the keywords The keywords used for this search included ‘‘subtalar,’’ ‘‘talar,’’ ‘‘talus,’’ ‘‘bone,’’ ‘‘block,’’ ‘distraction,’ ‘arthrodesis,’ ‘fusion,’ ‘arthritis,’ ‘arthrosis,’ ‘calcaneus,’ ‘calcaneal,’ ‘fracture,’ ‘malunion,’ ‘deformity,’ and ‘‘clinical outcome,’’ alone and in various combinations using the Boolean operator ‘‘AND.’’ Data abstraction was performed by two independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least five patients, (4) reporting clinical and/or radiographic outcomes of SDA. Data collected included: demographics, operative techniques, radiographic measures, clinical and functional outcomes, and complications. The level of evidence for each study was assessed according to the method described by Wright et al. Methods followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle hindfoot scores with a weighted average of 33 points of improvement. Conclusion: Subtalar bone block arthrodesis provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. These consistent clinical outcomes throughout the literature, despite different lengths of followup periods, suggest that the functional results do not deteriorate with time. Higher confidence recommendations for SDA require longer follow-up, clear indications and treatment protocols, standardized clinical and radiographic outcome measures, and direct comparison or stratification of results based on graft type and other operative techniques. [Table: see text]

Download Full-text

Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684092 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668409 ◽

Cited By ~ 5

Author(s):

Yoon Sang Jeon ◽

Chi Hoon Ahn ◽

Myung-Ku Kim

Keyword(s):

Articular Cartilage ◽

Clinical Outcome ◽

Mechanical Axis ◽

International Knee Documentation Committee ◽

Senior Author ◽

Tibial Osteotomy ◽

Vas Score ◽

Significant Difference ◽

Ikdc Score

Purpose: The purpose of this article was to assess the clinical outcome of high tibial osteotomy (HTO) with articular cartilage surgery compared with unicompartmental knee arthroplasty (UKA) in unicompartmental osteoarthritis (OA). Methods: We designed retrospective study and evaluated 47 patients with unicompartmental OA (Kellgren–Laurence [K–L] grade ≥III OA). Two groups of patients underwent either HTO with articular cartilage surgery or UKA by the senior author between January 2010 and April 2013. The minimum follow-up period is 2 years. Clinical outcomes were assessed using Knee Injury and Osteoarthritis Outcome Scores, International Knee Documentation Committee (IKDC), and visual analog scale (VAS) score. And we evaluated the radiologic result of HTO and UKA by measuring mechanical axis at preoperative period and at last follow-up. Results: The IKDC score was significantly better in the UKA group than in the HTO group at 6 months but there was no significant difference in the two groups at 2 years. The VAS score was improved at the final follow-up compared to before surgery in both groups and did not show significant intergroup difference ( p = 0.123). There was no significant difference in the preoperative mechanical axis in the two groups. But their mechanical axis at the final follow-up were significantly different ( p = 0.0001). Conclusion: The clinical outcome was significantly better in the UKA group at 6 months. But in the two groups, there were no significant differences at 12 months and 2-year follow-up, and the mechanical axis correction effect is greater than the UKA group. Based on our research, HTO with articular cartilage surgery can be considered as the treatment of choice for more active and younger patients with unicompartmental OA.

Download Full-text

Comparison of Screws to Plate-and-Screw Constructs for Midfoot Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000019 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Jamal Ahmad

Keyword(s):

Delayed Union ◽

High Rate ◽

Wound Complications ◽

Postoperative Function ◽

Pain Scores ◽

Orthopaedic Literature ◽

To Receive ◽

With Screws

Category: Midfoot/Forefoot Introduction/Purpose: Arthritis of the midfoot’s 1st, 2nd, and/or 3rd tarsometatarsal joints (TMTJ) are routinely treated with arthrodesis when nonsurgical treatments fail. This surgery is traditionally performed with trans-articular screws, but newer plate- and screw constructs placed across the TMTJs may confer greater rigidity to the midfoot fusion. While in vitro biomechanical studies show advantages to using plate-and-screws over screws to achieve a solid midfoot arthrodesis, there have yet to be clinical comparative investigations about this subject. The purpose of this study is to prospectively evaluate and compare clinical and radiographic outcomes of trans-articular screws versus plate-and screw constructs for arthrodesis of the midfoot’s 1st, 2nd, and/or 3rd TMTJs in a single surgeon’s practice. Methods: Between April 2010 and December 2015, 68 patients presented with arthritis of the 1st, 2nd, and/or 3rd TMTJs that failed nonsurgical management. Of these persons, 50 enrolled in this study to receive a midfoot arthrodesis with either trans- articular screws or plate-and screw constructs. On the day of surgery, 25 patients were randomized to receive 4.0 mm partially- threaded cannulated cancellous screws (Synthes, Paoli, PA) while the remaining 25 were randomized to receive plate-and-screws (ALPS, Biomet, Warsaw, IN) at their involved TMTJs. Preoperative and postoperative function and pain was graded using the Foot and Ankle Ability Measures (FAAM) Scoring System and a Visual Analog Scale (VAS) of pain respectively. Radiographs were assessed for bony healing and hardware stability at the arthrodesis. Postoperative data regarding complications and revision surgeries were also recorded. Patients were routinely followed for 12 months from arthrodesis and then invited for updated longer-term follow-up to collect further data. Results: Of 25 patients with screws for arthrodesis, 21 (84%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 46.4/100 and 8.3/10 preoperatively to 82.7/100 and 2.1/10 respectively at final follow-up. Three (12%) patients developed wound complications. Four patients (16%) experienced delayed union or nonunion of their arthrodesis. Of 25 patients with plate-and-screws for arthrodesis, 23 (92%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 48.2/100 and 8.0/10 preoperatively to 86.3/100 and 1.8/10 respectively at final follow-up, which were not significantly different from patients with screws. Six (24%) patients developed wound complications, which is significantly higher than patients with screws. Two (8%) patients experienced delayed union or nonunion of their arthrodesis, which is less than patients with screws. Conclusion: A comparison of outcomes from performing midfoot arthrodesis with screws or plate-and-screw constructs has not been previously reported in the orthopaedic literature. This study demonstrates that using either screws or plate-and-screw to achieve TMTJ fusion results in a high rate of improving midfoot function and pain. While using just screws generate significantly less wound complications (P<0.05), employing plate-and-screws produce less problems with delayed union or nonunion of the fusion (P=0.30). Studies with a larger patient population may be needed to further confirm these results when using different types of implants for midfoot arthrodesis.

Download Full-text

Early Outcomes on the Use of an Anterior Plate for complicated Ankle Fusions

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00195 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0019

Author(s):

J. Chris Coetzee ◽

Rebecca Stone

Keyword(s):

Plate Fixation ◽

Ankle Arthrodesis ◽

Senior Author ◽

Wound Complications ◽

X Rays ◽

Anterior Plate ◽

Non Union ◽

Ankle Fusion ◽

Major Complications

Category: Ankle Introduction/Purpose: An ankle fusion is indicated for severe osteoarthritis of the ankle. An anterior ankle fusion plate for tibiotalar fusions provides a rigid and reproducible solution to treat ankle arthritis. With a plate fixation it might be possible to treat more complex deformities and provide additional stability in compromised patients. This study documents the early outcomes on the use of an anterior plate for patients undergoing an ankle arthrodesis. Methods: All ankle fusions using the anterior plate at our center were included and followed. Fifty-one patients (53 ankles) presented to the senior author between September 2014 and February 2017. Patients experienced ongoing ankle pain due to degenerative changes, a previous ankle fusion, post-traumatic arthritis (PTA) or failure of a total ankle arthroplasty (TAA). All patients’ medical and ankle surgical history was documented. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS) and Visual Analog Scale (VAS) Pain scale. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 16.8 months (range 6 – 38 months). Results: Fifty-one patients(29 females) with the mean age of 56.56 years(26.3–74.8) had a mean follow-up of 16.6months(6– 38months). Diagnoses included 17 primary, 10 revision, 6 TAA failures and 20 PTA. 86.3%(44 patients) were non-diabetic. Non-smokers included 43.1%(22). VR-12 Physical improved from 29.46 to 37.72, and Mental 47.34 to 52.55 pre-operatively to post-operatively, respectively. AOS Pain improved: 462.41 to 252.8; AOS Disability: 567.52 to latest 387.77. Mean VAS improved from pre-operatively of 54.28 to latest of 30.61. Arthrodesis rate was 98%(52/53 ankles). 45 ankles were fused at 3 months by x-rays. Symptomatic patients (with pain) had a CT scan done at a minimum of 3 months (1/8 CT scans showed non-union & 7 were fused). Major complications were 3.8%(2 patients). There were no wound complications. Conclusion: An anterior plate construct is more invasive compared to arthroscopic or other arthrodesis options. However, the stability of the construct allows for a reliable option in complex situations, and the arthrodesis rate appears to be exceptional. In this complex patient population, the arthrodesis rate was 98%, while major complications only 4%. Summary Sentence: Anterior plate construct is more invasive compared to arthroscopic/other arthrodesis options. However, stability of the construct allows for a reliable option and fusion rates seem to be exceptional.

Download Full-text

Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.40 ◽

2021 ◽

Vol 32 (2) ◽

pp. 397-405

Author(s):

Mehmet Baydar ◽

Abdurrahman Aydın ◽

Ayşe Şencan ◽

Osman Orman ◽

Serkan Aykut ◽

...

Keyword(s):

Grip Strength ◽

Kirschner Wire ◽

Operation Time ◽

Wound Complications ◽

Radiographic Outcomes ◽

Significant Difference ◽

Wire Fixation ◽

K Wires ◽

Surgery Duration

Objectives: In this study, we aimed to compare clinical and radiographic outcomes of retrograde intramedullary Kirschner-wire (K-wire) fixation with those of plate-screw (PS) fixation. Patients and methods: A total of 98 metacarpal shaft fractures in 75 patients (65 males, 10 females; mean age: 31.2±10.9 years; range, 16 to 65 years) were included between January 2011 and December 2017. The total joint active range of motion (AROM) and grip strength of the healthy and broken hands were evaluated. The Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded. We compared surgery duration, number of fluoroscopy images, and cost-effectiveness for each technique. Results: The overall mean follow-up was 21.9 (range, 12 to 56) months. At the last follow-up, total joint AROM (p=0.072), VAS score (p=0.298), QuickDASH score (p=0.132), and hand grip strength (p=0.947) were similar between the groups. Radiological union occurred in the PS and K-wire groups in a mean of 5.84 (range, 3 to 8) and 4.46 (range, 3 to 20) weeks, respectively (p=0.173). A significant difference was found in surgery duration (p=0.021) and number of fluoroscopy images (p<0.05) between the PS and K-wire groups. Two wound complications were observed in the PS group and one with K-wires. Conclusion: Retrograde intramedullary K-wire fixation has certain advantages such as being less invasive and more accessible with shorter operation time, compared to PS fixation. Similar radiological and clinical scores can be obtained in patients undergoing retrograde intramedullary K-wire fixation or PS fixation.

Download Full-text